Archive for category ObamaCare

One of the challenges in managing health care costs is the way in which they’re distributed across the population.

According to the Agency on Healthcare Research and Quality, in any year 5% of the population accounts for 50% of health care expenditures, the top 10% of health care users account for 64% of overall spending. In any given year, 50% of the population accounts for only 3% of overall health care spending. To put it another way, 50% of the population accounts for 97% of health care spending. These numbers have been relatively stable since the 1970s. Half the population is responsible for a negligible portion of overall healthcare spending in any given year.

Who are the 5% that spends half the health care dollars in any year? They are persons with cancer, heart disease, pulmonary disease, mood disorders, and trauma.

To put it another way, healthcare spending is concentrated on a small portion of the population during any given year. The problem in managing health care costs whether it’s at a personal level or at the national level is their unpredictability.

We don’t know which persons are going to be in accidents or be diagnosed with cancer or heart disease in any given year. In our system, even persons without insurance, receive treatment; given the massive costs of the big five, those persons are likely going to not be able to pay the bills. So they get spread to the rest of us in the least efficient way possible.

Many of the individual plans that have caused the brouhaha about their cancellation don’t meet ACA minimum coverage standards. That’s why they’re being cancelled. At a consumer level, they were crappy products – people paid for them and got little for them in return. The reason the ACA established minimum levels of coverage was simply because people with inadequate health insurance are a lot like people without any health insurance.

Like this:

But the sabotage is a story, too. A huge one. It’s almost without precedent in American history, and the precedent it does have includes some of the ugliest chapters in this nation’s history. It gets coverage, yes. But not nearly the coverage it deserves. As is so often the case—as with Benghazi, as with Fast and Furious, as with the IRS—the bigger scandal is on the Republican side.

What’s that precedent?

. . . to find obstinacy like this, you have to go back, yes, to the pre-Civil War era. The tariff of 1828, the Kansas-Nebraska Act, which led to the civil war in “Bloody Kansas” and ultimately to the Civil War itself. Not comforting thought. But it’s where we are.

Then, in the months leading up to the program’s debut, some states refused to do anything at all to educate the public about the law. And congressional Republicans sent so many burdensome queries to local hospitals and nonprofits gearing up to help consumers navigate the new system face-to-face that at least two such groups returned their federal grants and gave up the effort. When the White House let it be known last summer that it was in talks with the National Football League to enlist star athletes to help promote the law, the Senate’s top two Republicans sent the league an ominous letter wondering why it would “risk damaging its inclusive and apolitical brand.” The NFL backed off.

Now, with people trying to sign up, some Republican legislators are openly saying that they won’t permit their staffs to answer constituents’ questions about Obamacare. This is really the main job of a member of Congress, especially a House member: People call up all the time with questions about how to slice their way through the federal government’s briar patches, and you have caseworkers on duty—typically a couple in Washington and several more back home in the district regional offices—whose job is exactly that.

Purdum quoted Kansas Rep. Tim Huelskamp as saying he instructs his staff to refer callers to Kathleen Sebelius. But Huelskamp is not alone. Tennessee’s Diane Black says she doesn’t feel comfortable referring people to navigators. Utah’s Jason Chaffetz is referring people back to the administration, saying: “We know how to forward a phone call.”

This chart shows both the increase in revenues and costs and the line in the middle shows the impact on the deficit by year. If the line is below zero then it reduces the deficit and if the line is above zero – it increases the deficit. You can see…the estimate is that it reduces the deficit: Source

The new estimates reflect a couple of factors. The Congressional Budget Office lists them:

- An increase of $168 billion in projected outlays for Medicaid and CHIP;
– A decrease of $97 billion in projected costs for exchange subsidies and related spending;
– A decrease of $20 billion in the cost of tax credits for small employers; and
– An additional $99 billion in net deficit reductions from penalty payments, the excise tax on high-premium insurance plans, and other effects on tax revenues and outlays—with most of those effects reflecting changes in revenues.

Jonathan Cohn at the New Republic digs into the details and rebuts those Republicans who INCORRECTLY say Obamacare now costs double:

To figure out the cost of health care reform, CBO looks at each of the law’s component parts and, for accounting purposes, groups them into different categories. It calls one category “gross cost of coverage expansions” – that’s the amount of money the federal government will spend to help people get insurance, mostly by offering Medicaid to more people or giving people subsidies they can use to help offset the cost of private insurance. Last year, CBO estimated that the gross cost of coverage expansion from 2012 through 2021 would be $1.445 trillion. Now CBO thinks the gross cost will be $1.496 trillion. The number shifted, in part, because the CBO has changed its projections for economic growth. (MSNBC’s Tom Curry has a nice explanation of this.) But, in the context of such a large a budget projection, that’s barely any difference at all.

With shutdown fever gripping the Republican party and the commentariat, it’s easy to argue the Republicans have clearly gone insane. Their tactics – from repeatedly holding votes to repeal the ACA to threatening to shutdown the government to threatening to crash the world economy by refusing to raise the debt limit – are self destructive behaviors of a party gone crazy. I disagree. Republicans have not gone crazy. From the conservative perspective, America is careening wildly toward destruction – worse it’s self-destruction in the form of “creeping socialism” symbolized by the Affordable Care Act. Republicans are pursuing tactics that can be understood simply as “Desperate times require desperate measures.”

Conservative critiques of the ACA portray it as a government takeover of health care that will lead to catastrophic outcomes – brutal rationing of care and prescription medications, senior citizens denied health care, a nameless faceless board in DC dictating to doctors what treatment their patients can receive (one scenario actually included doctors being issued government controlled iPads that would transmit treatment instructions from DC to the doctors – my boss made company management attend a speech by the ill informed MD claiming this outcome). If you live in Teabagistan, you’ve heard these stories and you’ve never heard them debunked. You and your friends have linked and shared atrocity tales about the outcomes of socialized medicine in other countries (a favorite meme is that Canadians are all frantic to come the US for health care because they’re being denied life saving treatment in Canada – usually some experimental treatment). Again, those stories have been debunked but you’ve never heard it because in Teabagistan, nobody hears the debunking and if they do, they dismiss it as a liberal conspiracy. For the teabaggers, the ACA is not just a bad policy, it is an existential threat to America. If it is allowed to go into full effect, the ACA will destroy America.

Believing we face such dire circumstances, the teaparty contingent in Congress (driven by their base which believes we face such circumstances), is fully prepared to do anything to “save” America. They were sure the Supreme Court would strike down the ACA. They were certain they could recapture the Senate and White House in 2012. Those things didn’t happen. Legitimate, normal avenues of preventing the ACA from taking effect, normal avenues for repealing it were closed. Repeated House votes to repeal it haven’t worked (despite the obvious problem with those repeated votes, conservative voters read articles saying “House votes to Repeal Obamacare” and then read that it’s still going into effect and conclude some devious force must be at work to frustrate an outcome they believe should be happening). So conservatives are left with drastic measures. If you genuinely believe the ACA is an America destroying bill, a government shutdown and all the attendant disruption is a small price to pay to “save” America. It doesn’t hurt that many teabaggers genuinely believe the government is irrelevant on a daily basis anyway.

Better to suffer through what conservatives believe will be short term discomfort than allow the ACA catastrophe to occur.

This month, millions of Americans will receive letters from their employers explaining the state health insurance marketplaces (formerly known as exchanges). I know because my job required me to send the letter to a sizable number of people.

If past experience is any guide, at least two-thirds of the people who receive the letter will glance at it, be confused and come to my office with questions already answered in the letter. The remaining third will be split between people who threw it away without reading it, people who read and understood it, and people who didn’t read it, didn’t understand it and are confused and/or angry. People have heard so much disinformation that I will spend the rest of the month and probably a good chunk of October debunking lies, correcting misinformation and calming terrified people. Read the rest of this entry »

LOUISVILLE, Ky. — A middle-aged man in a red golf shirt shuffles up to a small folding table with gold trim, in a booth adorned with a flotilla of helium balloons, where government workers at the Kentucky State Fair are hawking the virtues of Kynect, the state’s health benefit exchange established by Obamacare.

The man is impressed. “This beats Obamacare I hope,” he mutters to one of the workers.

“Do I burst his bubble?” wonders Reina Diaz-Dempsey, overseeing the operation. She doesn’t. If he signs up, it’s a win-win, whether he knows he’s been ensnared by Obamacare or not.

Since the many exchanges will be run by the states (Utah included), the dreaded Federal takeover of health care won’t happen.

The crush of people don’t greet Diaz-Dempsey with tea party dogma or amateur constitutional scholarship. No one is there to complain about the individual mandate or heckle about death panels. They have questions.

They wonder if they could get coverage despite having a pre-existing medical condition, how much it will cost them. They ask if Indiana has a similar program, or if this was only for Kentucky. Could they just enroll their child? They talk about their sons and daughters, neighbors going without health care, and ask about the subsidies.

The vast majority are relieved to learn about the health exchange. Linda Parrish, 47, showed up at the table and gushed to Diaz-Dempsey: “This is what I’ve been waiting on.” Parrish has health insurance, but her best friend doesn’t.

If people sign up through the state exchanges and get insurance believing they’ve somehow avoided the dreaded Obamacare and then don’t have to pay fines because they have insurance, they’re going to be relieved. The law will have done what it was designed to do, namely get more people covered by insurance – which is a good thing.

Our conservative peers have now spent close to five years in near hysterics about health care reform. We’ve been subjected to never ending flow of lies and a veritable ocean of disinformation. If that disinformation campaign ends up helping the law, that would be at least a little bit funny.

That was then, this is now. These days, Heritage president and former South Carolina senator Jim DeMint is on a campaign to convince Republicans to shut down the government in order to defund the Affordable Care Act. According to DeMint:

“This might be that last off-ramp to stop Obamacare before it becomes more enmeshed in our culture.” The law “is not about getting better health care,” he continued. Uninsured Americans “will get better health care just going to the emergency room.”

The so-called “free” care at emergency rooms is a result of The Emergency Medical Treatment and Active Labor Act or (EMTALA), which requires hospitals that accept Medicare or Medicaid funding to treat patients for emergency medical conditions regardless of legal status or ability to pay. But EMTALA only applies to medical emergencies like heart attacks or serious injury. It does not offer any treatment for chronic conditions, leaving the millions of Americans with diabetes who need regular access to medication to stay alive, or asthma patients, or women diagnosed with breast cancer without access to care.

The right-wing keeps saying “just go to the emergency room,” and there is not enough push-back on that from the reality-based community.

Like this:

Last week, Politico was flogging a story in which there is going to be, if it hasn’t already started, a mass exodus of Congressional staffers due to Obamacare.

Like many Politico stories, it contained only part of the truth. Per Joan McCarter:

Here’s the story. Congress is talking about how figure out what to do with itself, and its employees, after it let Sen. Chuck Grassley screw things up. See, Grassley thought he could make Democrats look bad by offering up an amendment to the Affordable Care Act that would force Congress onto the new health exchanges. The plan was, Democrats would reject it and look like hypocrites. Which they did not do. They adopted it.

The problem is, members of Congress and their staff are all employees of a very large employer, the federal government. In their wisdom, they didn’t pass a provision to go along with Grassley’s amendment to address this single large employer that would be forced onto the exchange. Large employers aren’t allowed on the exchanges until 2017, and will only be accepted at that time if the state decides to let them on. But right now, there are no procedures for handling premium contributions for large employers. This means that it’s possible the federal government wouldn’t pay the employer’s portion of health insurance premiums for members of Congress and staff.

There’s a deeper reality being revealed here. Today’s Republican party cares nothing about policy. They aren’t interested in it, they don’t try to understand it. Grassley’s amendment was offered for purely political reasons with no concern for the policy effects. So of course the real world policy effects are negative. Had Grassley simply left well enough alone, this wouldn’t be an issue. I’m also guessing he figured that even if it passed, the Dems would come along later and fix it which would give him political fodder (he’d scream about “Democrats exempting Congress from the law”). But that assumed Dems would retain control of the House. Republicans in the House care about policy even less than Senate Republicans. So the Grassley’s messed up Amendment remains in place and is panicking Republicans in Congress.

And of course, the folks at Politico.

The Office of Personnel Management, which oversees benefits for all federal employees, hasn’t determined their interpretation of the law yet, and is quite likely to decide that the federal government can continue to pay its part of employee benefits. As of this moment, this isn’t a real thing to panic about. But it’s a fun Obamacare scare story for Republicans and Politico.

Like this:

. . . looking even an inch beneath the surface reveals a public more frustrated and confused by Obamacare than opposed. Its specific elements poll well, though they’re the least known elements. Four out of ten Americans don’t realize the law hasn’t been struck down. A new poll out shows that the public, by a ten-point margin, trusts Democrats over Republicans on health-care issues. By a 52–34 percent margin, they want Congress to implement or tinker with the law rather than repeal it. The nearly ubiquitous conservative belief that the public shares its passion for repealing Obamacare is a spate of self-delusion. [snip]

The tiny kernel of truth is that a handful of people — mostly young, male, and healthy — will have to buy into some kind of regular insurance plan that covers stuff, not only plans that cover your costs if you’re injured in a car crash and make you pay for just about everything else. The scare campaign could work, at least to some extent. But if it works, it won’t work because Americans are dying to be converted to an all-catastrophic, high-deductible system.

What Republicans have going for them is that health care is really complicated, people don’t spend hours a day boning up on public policy, and those who have insurance understandably fear losing what they have. But the vast majority of the public is not going to see any changes under the new law. Even if the Obamacare exchanges collapse, they only bring in people who don’t have Medicare or employer coverage anyway and are already suffering through a dysfunctional individual insurance market. The “shock” is going to be felt by conservatives who are expecting their Randian fantasies of socialist dystopia to come true.

The tragedy is that our old system was utterly unworkable and the new system isn’t really much of a new system. The Affordable Care Act represents a serious attempt to fix a real world problem. It’s a Rube Goldberg device, doing in complicated ways what should have been done in simple ways. That said, full implementation has the potential to greatly benefit millions of Americans – simply removing the life time caps and the exclusions for pre-existing conditions will benefit people. The mandate isn’t all that scary since lots of people can simply pick up their employer’s insurance (FWIW, I’ve never understood why anyone would want to be without health insurance – all it takes is one night in the hospital to make it worth it). The real problem is the number of states opting out of the medicaid expansion, which will have a huge impact on those living in poverty.

The firm estimates that a typical family of four with an employer-sponsored health plan will end up incurring about $22,030 for all of their medical costs in 2013. That represents a 6.3 percent increase from last year, when the typical family racked up $20,728.

Too bad the so-called Affordable Care Act took the place of actual health care reform. We needed an expansion of Medicare, and all we got was the right-wing individual private insurance mandate without any cost controls (such as a public option).

Update 2.6.2012: It appears teapartycommunity.com blocked my IP, which is exposed by design in our comments. This is remarkable given the amount of effort that must have been invested to not only find this post, but to inspect the comments in order to discover my IP address. My next post on the subject will be about the astounding hypocrisy of the underlying justification for starting TeaPartyCommunity.com

Perusing the new TeaPartyCommunity.com Facebook-like platform, I was riveted by “Cade’s comment” as an excellent illustration of the tension between high self-conviction and low emotional intelligence in the conservative religious mind.

…which compelled me to read the top post “My Conundrum” which struck me as so perfectly juxtaposed to Cade’s comment as an example of the opposite tension, lower self-conviction, higher emotional intelligence. “My Conundrum” is posted also in its entirety below Cade’s comment immediately below.

“Christopher Noyes – Well Cade, you are what we call around here, complicated. Truth is we all are complicated, how we resolve inner conflict plays a big part in determining our character.

First, you did not abuse the safety net, and I do not believe the safety net ought to be removed. The problem with the safety net is the abuse of it that is cultivated and facilitated for either criminal or political reasons. It is there for people who, like you, had an untimely life threatening event, an emergency of life or death. Reforms may not be able to correct the safety net, and I would rather see it in the hands of the church like it was at one time, but the truth is the only way the government got a foot hold into social welfare is the church abdicated its responsibility a long time ago.

Second, God has never left you, he does not despise you, he has brought all of these things in your life for your edification because you are his adopted son and he loves you. Read the rest of this entry »